title: The effects of augmented visual feedback during balance training in Parkinson's disease: study design of a randomized clinical trial.
abstract: BACKGROUND
  Patients with Parkinson's disease often suffer from reduced mobility due to impaired postural control. Balance exercises form an integral part of rehabilitative therapy but the effectiveness of existing interventions is limited. Recent technological advances allow for providing enhanced visual feedback in the context of computer games, which provide an attractive alternative to conventional therapy. The objective of this randomized clinical trial is to investigate whether a training program capitalizing on virtual-reality-based visual feedback is more effective than an equally-dosed conventional training in improving standing balance performance in patients with Parkinson's disease.
  
  
  METHODS
  Patients with idiopathic Parkinson's disease will participate in a five-week balance training program comprising ten treatment sessions of 60 minutes each. Participants will be randomly allocated to (1) an experimental group that will receive balance training using augmented visual feedback, or (2) a control group that will receive balance training in accordance with current physical therapy guidelines for Parkinson's disease patients. Training sessions consist of task-specific exercises that are organized as a series of workstations. Assessments will take place before training, at six weeks, and at twelve weeks follow-up. The functional reach test will serve as the primary outcome measure supplemented by comprehensive assessments of functional balance, posturography, and electroencephalography.
  
  
  CONCLUSIONS
  We hypothesize that balance training based on visual feedback will show greater improvements on standing balance performance than conventional balance training. In addition, we expect that learning new control strategies will be visible in the co-registered posturographic recordings but also through changes in functional connectivity.
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands. e.vanwegen@vumc.nl.
authors.forename: Maarten R C
authors.initials: MR
authors.lastname: van den Heuvel
authors.forename: Erwin E H
authors.initials: EE
authors.lastname: van Wegen
authors.forename: Cees J T
authors.initials: CJ
authors.lastname: de Goede
authors.forename: Ingrid A L
authors.initials: IA
authors.lastname: Burgers-Bots
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Beek
authors.forename: Andreas
authors.initials: A
authors.lastname: Daffertshofer
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000704:Analysis of Variance; D004569:Electroencephalography; D005081:Exercise Therapy / Q000379:methods*; D056228:Feedback, Sensory / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009068:Movement; D010300:Parkinson Disease / Q000503:physiopathology / Q000534:rehabilitation*; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology*; D013997:Time Factors